McIntosh Georgia E, Liu Edward S, Allan Michelle, Grech Lisa B
Department of Medicine (GEM, ESL, MA, LBG), School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University; Department of Neurology (MA), Monash Medical Centre, Monash Health, Clayton; and Department of Neurology (MA), Frankston Hospital, Peninsula Health, Frankston, Australia.
Neurol Clin Pract. 2023 Jun;13(3):e200154. doi: 10.1212/CPJ.0000000000200154. Epub 2023 Apr 25.
The association of multiple sclerosis (MS) with depression has been well documented; however, it frequently remains undiagnosed, untreated, or undertreated, with consequences to the person, family, and economy. The aim of this study was to determine the quality, scope, and consistency of available guidelines and consensus statements to guide clinicians managing people with comorbid MS and depression.
Based on our systematic search of the literature, 6 guidelines and consensus statements met the inclusion criteria. Of these, 4 presented recommendations on depression screening in MS and 5 offered recommendations for treatment. Despite most guidelines presenting evidence-based recommendations, they were generally of low-quality evidence overall. Inconsistencies identified across guidelines and consensus statements included variations in recommendation for routine screening and which screening tool to use. Most guidelines lacked detail, often referring to general population guidelines without describing to what extent they can be applied to people with MS.
The findings of this review highlight the need to develop high-quality, comprehensive clinical practice guidelines with clear recommendations that can be globally implemented by healthcare clinicians working with people with MS.
多发性硬化症（MS）与抑郁症之间的关联已有充分记录；然而，这种关联常常仍未得到诊断、治疗或治疗不足，这会对患者本人、家庭和经济造成影响。本研究的目的是确定现有指南和共识声明的质量、范围和一致性，以指导临床医生管理患有MS合并抑郁症的患者。
基于我们对文献的系统检索，6项指南和共识声明符合纳入标准。其中，4项针对MS患者的抑郁症筛查提出了建议，5项提供了治疗建议。尽管大多数指南提出了基于证据的建议，但总体而言证据质量较低。指南和共识声明中发现的不一致之处包括常规筛查建议的差异以及使用何种筛查工具。大多数指南缺乏细节，常常引用一般人群指南，却未说明它们在多大程度上可应用于MS患者。
本综述的结果凸显了制定高质量、全面的临床实践指南的必要性，这些指南应具有明确的建议，可供治疗MS患者的医疗保健临床医生在全球范围内实施。
